Medicare Fraud Investigator Resume

[First Name] [Last Name]

Contact Address: [street] [Country] [City] [State/Province] [Zip Code]

Contact Number: (012)-345-6789

Email Address: [[email protected]]

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Career Objective:

To obtain a Medicare Fraud Investigator position with “ProgressiveMed” and conduct comprehensive evaluation of submitted claims, medical records, and supporting documents.

Summary of Skills:

  • Experienced in identifying fraud happening under the Medicare program
  • Excellent understanding of data analysis techniques and statistics
  • Good knowledge of laws and regulations related to medical industry
  • Skilled in conducting research and drawing conclusions
  • Expert in citing regulatory violations, and unnecessary inflating of medical bills
  • Ability to get to the depth of fraud schemes initiated for defrauding the Government
  • Remarkable computer, communication, and interpersonal skills

Work Experience:

Medicare Fraud Investigator
Arlington Hospital, Arlington, TX
March 2012 – Present

  • Investigate independently all fraud schemes and claims
  • Identify discrepancies in Medicare claim data
  • Find out the trails of fraud scams and get to the real source of origin
  • Proceed paperworks to recovered overpaid money
  • Detect unnecessary inflation of billing and abuse of medical practice
  • Develop and implement system that detect potent fraud scheme
  • Conduct audits in cooperation with the investigation development

Medicare Fraud Investigator
Hope Medicare Center, Arlington, TX
August 2010 – February 2012

  • Utilized data analysis techniques and identified discrepancies in Medicare claims data
  • Reviewed standard claims processing systems files and detected potential fraudulent acts
  • Collected, compiled, and analyzed medical records and billing copies
  • Checked the rates charges for each services and verified with the billing code
  • Communicated with patients and guided them on filling claim forms
  • Supported the hospital staff in abuse case by gathering evidence in their favor
  • Reported errors in billing to the higher authority and issued warning to the billing clerk


  • Bachelor’s Degree in Hospital Manager
    Arlington University, Arlington, TX


On request.

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